Health Centers

What is obesity?
Being somewhat "overweight" by modern medical standards may not be unhealthy at all. Since fat is our reserve of energy, people who carry some may be better able to handle severe or chronic illness or stress. But if your fat percentage becomes excessive, you will encounter increased risks to your health. There are multiple methods to determine if a person is obese, but many experts believe that a person's body mass index (BMI) is the most accurate measurement of body fat for children and adults. BMI is calculated by dividing weight (in kilograms) by height (in meters) squared. This BMI calculator from the NIH is good one to keep handy.

Adults with a BMI between 25 and 29.9 are considered overweight. Adults with a BMI greater than 30 are considered obese. There are exceptions. For example, an athlete may have a higher BMI but not be overweight. An individual who is more than 100 pounds overweight is considered morbidly obese. Obesity increases a person's risk of illness and death due to diabetes, stroke, heart disease, high blood pressure, high cholesterol, and kidney and gallbladder disease. Obesity may increase the risk for some types of cancer. It is also a risk factor for the development of osteoarthritis and sleep apnea.

What are the causes of obesity?
Consuming more calories than you burn leads to being overweight and, eventually, obesity. The body stores unused calories as fat. Genetic factors also play some role in the development of obesity - children of obese parents are 10 times more likely to be obese than children with parents of normal weight. It can be difficult, however, to tease apart genetic and lifestyle factors, as children of obese parents may also be learning unhealthy eating and exercise habits.

One unique cause of the modern obesity epidemic may be high fructose corn syrup (HFCS), used to sweeten soft drinks and many other processed foods. Manufacturers began to use HFCS instead of old-fashioned corn syrup because it has a sweeter taste, blends well with other foods, maintains a longer shelf life and is cheaper. It has now become the main sweetener used in beverages. You will also find it in processed foods ranging from salad dressings and ketchup, to jams, jellies, ice cream and many others - even bread, of all things. HFCS contains 14 percent fructose, much more than regular corn syrup, and I am concerned about its potentially disruptive effects on metabolism. The body does not utilize fructose well, and never before in history have people been consuming so much of it. HCFS may promote weight gain because it behaves in the body more like fat than glucose, the blood sugar derived from other sweet foods. Some evidence suggests that fructose may also disturb liver function. And unlike glucose, fructose doesn't appear to set in motion the process by which the body tells us it is full.

What is the conventional treatment of obesity?
Conventional physicians offer dietary and exercise plans of various kinds, and these may be quite effective.

I am more concerned about the recent trend toward surgical remedies for obesity. Two operations are performed to treat morbid obesity. One is vertical banded gastroplexy, popularly known as "stomach stapling." The other is gastric bypass (more precisely, the Roux-en-Y procedure). Gastric bypass has become the gold standard of therapy because of the limitations of stomach stapling, which result in less weight loss than the bypass procedure and can fail over time, leading to regained weight or the need for repeat surgery.

Using the bypass procedure, surgeons divide the stomach into unequal parts, with the small part forming a pouch that limits how much one can eat or drink at a given time. This pouch is then connected to the small intestine beyond the area where most food usually is absorbed. In addition to morbid obesity, the procedure is considered appropriate only for those who are significantly overweight and have a life-threatening condition such as heart disease, diabetes or severe sleep apnea.

The surgery may be lifesaving for those who haven't been able to lose weight any other way despite repeated attempts. Within the first 18 to 24 months after the operation, most patients lose weight quickly and many maintain a long-term weight loss of as much as 100 pounds. According to the National Institute of Diabetes and Digestive and Kidney Diseases, in one study blood sugar levels in 83 percent of obese patients with diabetes returned to normal after surgery. Women in their reproductive years who want to have children can do so after the surgery but should wait until their weight stabilizes since rapid weight loss and the nutritional deficiencies that can occur after surgery may harm a developing fetus. Here are the principal risks of the surgery:

Between 10 and 20 percent of patients will require follow-up operations to correct complications, usually an abdominal hernia. Less common complications include breakdown of the staple line and stretched stomach outlets. There are also risks of bowel obstruction and leaking or narrowing of the site where the stomach pouch is reconnected to the small intestine.

Some patients develop gallstones, which are always a risk with rapid weight loss. Taking supplemental bile salts for the first six months after surgery can help prevent gallstones.

Nearly 30 percent of patients develop such nutritional deficiencies as anemia, osteoporosis and metabolic bone diseases. These problems can usually be avoided by taking the recommended supplements of iron, calcium, vitamin B12 and folic acid, which you will need to continue for the rest of your life.

What therapies does Dr. Weil recommend for obesity?
Methods for losing weight and maintaining ideal weight are essentially the same - when weight loss is the goal, you must simply be more diligent about following the necessary steps.

Join a support group (see eating disorders - support group). Many people find it easier to follow a diet and exercise program if they join a group of people with similar problems.

Be sure to set realistic goals for weight loss. A loss of 1 to 2.5 pounds a week may seem slow, but losing weight too quickly often does not work. Weight lost quickly usually comes back quickly. Children are becoming overweight and obese in America at an alarming rate. Here are steps I recommend you can take to help kids form new health habits that should have a positive impact on their weight:

Eat meals together. This will give you more control over the food your children eat. Learn about differences between good and bad fats and good and bad carbohydrates. Minimize consumption of fast food and snack foods.

Consult The Healthy Kitchen - the book I wrote with Rosie Daley - for concise information on nutrition as well as easy recipes. Family mealtimes also give parents an opportunity to find out what their kids are worried about so they can address any stress that might underlie emotional eating.

Encourage physical activity. Schools have cut back on physical education classes and extracurricular sports programs so it's now up to parents to make sure that their kids get daily exercise. Try to make this a family activity.

Curb screen time: Limit the time your children watch television, play video games or sit at the computer.

One more unusual weight-loss tip: A study published in the Journal of the Japan Society for the Study of Obesity found that people who brush their teeth after every meal tend to remain slimmer than those who don't brush as often. Japanese researchers discovered this effect when they compared the lifestyle habits of nearly 14,000 people whose average age was the mid-forties. They concluded that tooth brushing is a good health habit that could play a role in preventing obesity.

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